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Trial registered on ANZCTR

Registration number

ACTRN12615001157561

Ethics application status

Approved

Date submitted

17/08/2015

Date registered

29/10/2015

Date last updated

1/11/2017

Type of registration

Retrospectively registered

Titles & IDs

Public title

Care coordination through Emergency Department, Residential Aged Care and Primary Health Collaboration.

Scientific title

Care coordination through Emergency Department, Residential Aged Care and Primary Health Collaboration: effect on Hospital and ED admission, Length of stay, cost effectiveness, service delivery and patient satisfaction.

Secondary ID [1]

Nil

Universal Trial Number (UTN)

U1111-1173-1375

Trial acronym

The CEDRiC Project

Linked study record

Health condition

Health condition(s) or problem(s) studied:

Chronic disease

Acute illness

Condition category

Condition code

Public Health

Health service research

Intervention/exposure

Study type

Interventional

Description of intervention(s) / exposure

ARM 1. Health Intervention Projects for Seniors (HIPS) - Residential Aged Care Facility (RACF) and primary health sector mediated interventions including provision of a Nurse Practitioner Candidate (NPC) within the RACFs to support an enhanced model of Primary Health Care encompassing general practitioners (GP); development of advanced care plans for residents; better coordination of GP care in the RACF; a training program for RACF staff; and development of a sustainable model of care through endorsed NP medicare billing.
ARM 2. Geriatric Emergency Department Intervention (GEDI) - Hospital ED mediated interventions (Clinical Nurse Consultant (CNC) and Clinical Nurses (CN) with further education/experience in gerontology and community health) providing a dedicated single point of contact within the ED for RACF and primary health professionals; rapid and comprehensive assessment of RACF residents on presentation; streamlined patient flow in ED; clear and timely intersectoral communication; focused discharge planning and health professional education and training
a) How each intervention component is practically administered – Arm 1: The NPC supports the model of primary healthcare via:
* Clinically reviewing RACF elders upon referral by the RACF nurse or as requested by the elder themselves.
* liaising with GPs to order medications and tests
* facilitates development of advanced care plans for elders in coordination with GP
* provides one-on-one education to RACF staff in the review and care of specific elders at the bedside. The amount, type and length of training is determined by the NPC of the clinical service based on assessment of the situation and by the needs of the clinician. There is no formal education program in place
Arm 2 - GEDI nurses will screen all people presenting to the ED who are 70 years of age and over or those who appear extremely frail. These nurses will provide frontload assessment, liaise with family, GP, other support services to collect all relevant information, discuss disposition planning with medical team and provide age appropriate interventions in the ED. Health professional education and training in ED is facilitated via GEDI nurses and Gerontology physician providing education sessions attended by ED staff on each shift changeover for up to 1 hour. One-on-one education with primary care staff in ED while reviewing patients presenting to ED will be provided. This will be a decision for the clinical service GEDI team and determined by the needs of the clinician by the GEDI CN or CNC
b) The intervention will be evaluated for 12 months
c) Strategies to monitor adherence – ongoing regular meetings both internal with research team, external with the CEDRiC team and expert advisory committee, time and motion studies of both the NPC and GEDI nurses.

Intervention code [1]

Treatment: Other

Intervention code [2]

Prevention

Comparator / control treatment

ED data collected at participating hospital for the 12 months prior to commencement of the interventions.

Control group

Historical

Outcomes

Primary outcome [1]

ED re-presentation within 72hours and 28 days

Timepoint [1]

Outcome assessed via hospital records for ED re-presentations 72 hours and 28 days post discharge

Primary outcome [2]

Avoided transfer to hospital - elder remained at the RACF for illness duration under care directions of NPC

Timepoint [2]

Outcome assessed via RACF records demonstrating they remained at the RACF measured at any point during the 12 month intervention.

Secondary outcome [1]

Cost effectiveness of dual model of care

Timepoint [1]

Outcome assessed via cost effectiveness analysis for duration of the project

Secondary outcome [2]

ED length of stay from >=70 years cohort seen by GEDI

Timepoint [2]

From of admission to ED until time of discharge to ward, home or RACF. Outcome assessed via hospital records for duration of project

Secondary outcome [3]

Hospital admissions from >=70 years cohort seen by GEDI

Timepoint [3]

From time of admission to ED until time of discharge to ward, home or RACF. Outcome assessed via hospital records for duration of project

Eligibility

Key inclusion criteria

Arm 1: People aged 70 years or older who present to participating hospital ED.
Arm 2: RACF residents

Minimum age

70 Years

Maximum age

No limit

Sex

Both males and females

Can healthy volunteers participate?

Key exclusion criteria

Arm 1: People younger than 70 years who present to participating hospital ED.

Study design

Purpose of the study

Prevention

Allocation to intervention

Non-randomised trial

Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)

Methods used to generate the sequence in which subjects will be randomised (sequence generation)

Masking / blinding

Who is / are masked / blinded?

Intervention assignment

Other design features

Phase

Not Applicable

Type of endpoint/s

Statistical methods / analysis

Recruitment

Recruitment status

Completed

Date of first participant enrolment

Anticipated

Actual

1/07/2015

Date of last participant enrolment

Anticipated

11/10/2016

Actual

30/09/2016

Date of last data collection

Anticipated

30/11/2016

Actual

30/09/2016

Sample size

Target

1200

Accrual to date

Final

2496

Recruitment in Australia

Recruitment state(s)

QLD

Recruitment hospital [1]

Nambour General Hospital - Nambour

Recruitment postcode(s) [1]

4560 - Nambour

Funding & Sponsors

Funding source category [1]

Government body

Name [1]

Department of Social Services

Address [1]

Aged Care Workforce Grants
Delivery Operations Branch
Department of Social Services
GPO Box 7576
Canberra Business Centre ACT 2610

Country [1]

Australia

Primary sponsor type

University

Name

University of the Sunshine Coast

Address

90 Sippy Downs Drive, Sippy Downs QLD 4556, Australia

Country

Australia

Secondary sponsor category [1]

None

Name [1]

Address [1]

Country [1]

Ethics approval

Ethics application status

Approved

Ethics committee name [1]

Metro North Hospital and Health Service

Ethics committee address [1]

Human Research Ethics Committee
Metro North Hospital and Health Service
The Prince Charles Hospital
Building 14
Rode Road, Chermside QLD 4032

Ethics committee country [1]

Australia

Date submitted for ethics approval [1]

Approval date [1]

23/10/2014

Ethics approval number [1]

HREC/14/QPCH/220

Ethics committee name [2]

Sunshine Coast Hospital and Health Service

Ethics committee address [2]

Research Governance
Sunshine Coast Academic and Research Centre
5 Waterfall Rd
Nalbour, 4560

Ethics committee country [2]

Australia

Date submitted for ethics approval [2]

01/07/2015

Approval date [2]

10/09/2015

Ethics approval number [2]

HREC/14/QRCH/220 SSA/15/QNB/40

Ethics committee name [3]

University of the Sunshine Coast

Ethics committee address [3]

90 Sippy Downs Drive
Sippy Downs 4556

Ethics committee country [3]

Australia

Date submitted for ethics approval [3]

Approval date [3]

02/08/2015

Ethics approval number [3]

A/15/718

Summary

Brief summary

CEDRiC (Care coordination through Emergency Department, Residential Aged Care and PrImary Health Collaboration) is an innovative model of service delivery which aims to reduce RACF resident trauma and distress by reducing inappropriate transfer to the hospital emergency department (ED) and to maximise the care and efficiency of care where transfer to ED is appropriate.
CEDRiC has two interconnecting components: 
(i) the Health Intervention Program for Senior (HIPS) the provision of proactive care in the Residential Aged Care Facility (RACF) via a Nurse Practitioner Candidate (NPC) working closely with GPs and RACF staff; and
 (ii) Geriatric Emergency Department Intervention (GEDI) program advanced practice nurses in the ED who case manage older adults in the ED.
The aim of this trial is to determine the effect of the intervention via the outcomes. The trial aims to:
1.	Determine ED re-presentation rates up to 72 hours and 28 days for patient cohort seen by GEDI nurses compared with this not seen by GEDI nurses
2.	Determine number of RACF transfers avoided via NPC model of care
3.	Determine cost effectiveness and sustainability of the GEDI and NPC model of care
4.	Measure the ED length of stay on patient cohort seen by GEDI nurses compared with this not seen by GEDI nurses
5.	Measure the number of hospital admissions on patient cohort seen by GEDI nurses compared with this not seen by GEDI nurses 

Group matching will be undertaken from hospital data for the 12 months prior to implementation of interventions.

Trial website

http://www.usc.edu.au/connect/research/research-and-development/medical-and-health-science/nursing-and-midwifery-cluster-for-research-excellence

http://www.cedric.org.au

Trial related presentations / publications

Publications: Research Protocol paper
Marsden E, Taylor A, Wallis M, Craswell A, Broadbent M, Barnett A, Nguyen K, Crilly J, Johnston C, Glenwright A. (2017) A structure, process and outcome evaluation of the Geriatric Emergency Department Intervention model of care: a study protocol BMC Geriatrics, Mar 2017. DOI: 10.1186/s12877-017-0462-z  

Peer reviewed papers
 Craswell A, Marsden E, Taylor A, Wallis M. (2016) Emergency Department presentation of frail older people and interventions for management: Geriatric Emergency Department Intervention. Safety in Health, 2:14 DOI: 10.1186/s40886-016-0049-y  

Presentations as Invited speaker
 Marsden E, Taylor A, Wallis M (2017) GEDI information implementation workshop. RBWH, Brisbane, Australia 23 Feb 

 Wallis M, Marsden E. (2016) Keynote Address: Care Coordination through Emergency Department, Residential Aged Care and Primary Health Collaboration: The CEDRiC Trial. At: Preventing Unnecessary Hospital Emergency Department Transfers for Older People Conference, 5-6 May, Melbourne. 

 Marsden E, Taylor A. (2016) Overcoming the Discombobulation. Emergency Department Management Conference, 20-21 July Sydney. 

 Marsden E, Taylor A. (2016). The GEDI model. Presentation at Statewide Older Persons Acute Care Network Survey Forum, Brisbane, Australia, 7 June 

 Johnston C. (2016). Care Coordination through Emergency Department Residential Aged Care and Primary Health Collaboration. Data and Innovation Collaboration Networks Meeting, Caloundra, Australia, 25 May 

Conference Presentations

 Wallis M, Coates K, Johnston C, Bannink N. Craswell A. (2017) Changing care of the elderly in RACFs and EDs: The CEDRiC project toolkit implementation. National Nursing Forum, Sydney: 20-23rd Aug. 

 Craswell A, Coates K, Taylor A, Marsden E, Crilly J, Glenwright A, Wallis M. (2017) Streamlining care of older people in residential aged care: Nurse practitioner candidate and emergency department care coordination; Australian College of Nurse Practitioners Conference, Brisbane: 4-7 Sept. 

 Coates K, Wallis M, Craswell A, Glenwright A. (2017) A Nurse Practitioner Candidate: A model for change in aged care; Australian College of Nurse Practitioners Conference, Brisbane: 4-7 Sept. 

 Glenwright A, Coates K, Wallis M, Craswell A, Taylor A, Marsden EJ, Crilly J, Broadbent M, Johnston C. (2017). Care coordination between Emergency Departments, Residential aged care facilities and primary care Collaboration (CEDRiC). Primary Health Care Research and Information Service Conference, BCC, Brisbane: 7-9 Aug 

 Glenwright A, Coates K, Craswell A, Wallis M. (2017) Nurses at the forefront of system redesign: Advanced practice nurses improving quality of life for elders in residential aged care. International Council of Nurses Congress, Barcelona Spain: 27 May – 1 June 

Craswell, A., Wallis, M., Broadbent, M., Marsden, E., Coates, K., Taylor, A., Glenwright, A., Crilly, J. & Johnston, C. (2016). The CEDRiC project: Care coordination through emergency department, residential aged care and primary health collaboration. Presentation at Forum on Quality and Safety in Healthcare, Goteborg, Sweden, 13-15 April.

Coates, K. & Wallis, M. (2014). Innovative Partnerships for Improved Elder Care. Presentation at LASA International Conference, Adelaide, Australia, 20-23 October.

Marsden, E.J. & Taylor, A. GEDI & the Grey Tsunami. (2016) Presentation at Emergency Department Management Conference: Showcasing Innovation and Exploring Improvement Strategies, Sydney, Australia, 16-17 July.

Wallis, M., Broadbent, M., Marsden, E., Taylor, A., Coates, K., Craswell, A., Crilly, J. & Johnston, C. (2015). The CEDRiC Trial. Presentation at HITH @21 – Maturity, Responsibility, Quality Conference, Sydney, Australia, 11-13 November.

Wallis, M., Broadbent, M., Marsden, E., Taylor, A., Coates, K., Craswell, A., Crilly, J, & Johnston, C. (2015). The CEDRiC Trial. Presentation at USC School of Nursing, Midwifery and Paramedicine Research School, Sippy Downs, Australia, 12 November.

Craswell, A., Wallis, M., Marsden, E., Coates, K., Taylor, A., Broadbent, M., Crilly, J. & Johnston, C. (2015). Supporting appropriate transfer of older people: The CEDRiC model of care. Presentation at Australian Associate of Gerontology QLD Branch, Brisbane, Australia. 23 November.

Wallis, M., Broadbent, M., Marsden, E., Taylor, A., Coates, K., Craswell, A., Crilly, J. & Johnston, C. (2015). Who or what is CEDRiC? Presentation at USC Faculty of Science, Health, Engineering and Education Research Day, Sippy Downs, Australia, 24 November.

Craswell, A., Johnston, C. & Taylor, A. (2015) The GEDI Service. Nambour General Hospital Patient Safety Day, Nambour, Australia, 13 August.

Coates, K. (2016). A collaborative model for enhanced elder care. Presentation at Nurses: The Heart of Primary Care APNA National Conference, Melbourne, Australia, 5-6th May.

Glenwright, A. (2016). A cost analysis of a Geriatric Emergency Department Intervention (GEDI). Presentation at the International Federation of Ageing Conference, Brisbane, Australia, 21 June

OTHER PUBLICATIONS
Craswell, A., Taylor, A., Coates, K. & Broadbent, M. (2016). Care collaboration through emergency department residential aged care and primary health collaboration. Australian Nursing and Midwifery Journal, 23(7), 45.

Barr, J. (2014) SCML Senior’s Week – Innovative program reduces hospital admissions for seniors (Media Release) (WIN TV) Nambour, Australia, 18 August.

USC (Producer). (2015). The CEDRiC Trial [Video]. [With Wallis, M., Coates, K. & Taylor, A.]. Sippy Downs, Australia.

University of the Sunshine Coast. (2015). Better care for older residents. Engaged USC, July, 18-19.

Keeping seniors at home and out of emergency (2015, October 8). Nambour Weekly, p. 5.

Martin, K. (2015). Future Forecasting: Sundale positions itself for change. Australian Ageing Agenda, Nov/Dec, 36-39.

Nolan, A. (2016, 10 March). Emergency time halved: Special program ensures elderly receive medical care they need quickly. Nambour Weekly, p.3. 

AHHB (2016, 19 September) GEDI nurses – front line geriatric care. Australian Hospital and Healthcare Bulletin, Australia.
http://www.hospitalhealth.com.au/news/aged-care/new-hope-gedi-nurses-bringing-geriatric-care-front-line/ 

REPORTS

2013/14 Sunshine Coast Hospital and Health Service Quality of Care Report, 40-41 (p22 of PDF)

2014/15 Sunshine Coast Hospital and Health Service Quality of Care Report, 21

Public notes

Contacts

Principal investigator

Name

Prof Marianne Wallis

Address

University of the Sunshine Coast
School of Nursing, Midwifery and Paramedicine
Locked Bag 4
MAROOCHYDORE DC QLD 4558

Country

Australia

Phone

61 7 5456 5032

Fax

[email protected]

Contact person for public queries

Name

Alison Craswell

Address

University of the Sunshine Coast
School of Nursing, Midwifery and Paramedicine
Locked Bag 4
MAROOCHYDORE DC QLD 4558

Country

Australia

Phone

61 7 5456 3453

Fax

[email protected]

Contact person for scientific queries

Name

Marianne Wallis

Address

University of the Sunshine Coast
School of Nursing, Midwifery and Paramedicine
Locked Bag 4
MAROOCHYDORE DC QLD 4558

Country

Australia

Phone

61 7 5456 5032

Fax

[email protected]

No information has been provided regarding IPD availability

What supporting documents are/will be available?

No Supporting Document Provided

Results publications and other study-related documents

Documents added manually

Type	Is Peer Reviewed?	DOI	Citations or Other Details	Attachment
Plain language summary	No		Ageing populations are placing increasing pressure... [More Details]
Study results article	Yes		Wallis, M., Marsden, E., Taylor, A., Craswell, A.,... [More Details]

Documents added automatically

Source	Title	Year of Publication	DOI
Embase	A structure, process and outcome evaluation of the Geriatric Emergency Department Intervention model of care: a study protocol.	2017	https://dx.doi.org/10.1186/s12877-017-0462-z
Embase	The Geriatric Emergency Department Intervention model of care: a pragmatic trial.	2018	https://dx.doi.org/10.1186/s12877-018-0992-z

N.B. These documents automatically identified may not have been verified by the study sponsor.

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Documents added automatically